Hesperian Health Guides
Discomforts during pregnancy
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Many women experience discomfort during pregnancy. For some disabled women, the discomforts of their disability get worse, and for some they lessen.
Some discomforts of pregnancy, such as tiredness or back pain, are common to all women, including women with disabilities. What can be different for a disabled woman, though, is knowing if a problem is caused by her pregnancy or her disability. Be aware of what is normal for your body so you can tell the difference. Then you will be better able to get help when you go to see a health worker.
If you tend to get certain problems because of your disability, such as infections of the urine system because you have a spinal cord injury, then you may have these problems more often during pregnancy. Problems may improve or worsen at any time during your pregnancy, depending on your body and the baby’s development. Each and every woman makes adjustments in her life to accommodate her pregnancy.
Here are some changes that women with some disabilities might go through and suggestions for how to deal with them.
- 1 Feeling tired and sleepy
- 2 Sleeping difficulties
- 3 Swollen feet and legs
- 4 Movement and balance
- 5 Amputated leg
- 6 Muscle cramps
- 7 Muscle spasms
- 8 Back pain
- 9 Breathing difficulties
- 10 Aches and pains in the joints
- 11 Leaking urine
- 12 Difficulty passing stool (constipation)
- 13 Piles (hemorrhoids)
Feeling tired and sleepy
Most women feel tired and sleepy during the first 3 or 4 months of pregnancy. For more complete information about other possible causes, read about:
- anemia (Where Women Have No Doctor: Poor Nutrition Can Cause Disease).
- not eating enough of the right kinds of food (malnutrition), (Where Women Have No Doctor, Chapter 11: Eating for Good Health).
- emotional problems (Where Women Have No Doctor: Common Causes of Mental Health Problems in Women).
Many women have trouble sleeping at night during the last few weeks of pregnancy. This can happen because they need to pass urine during the night, or because of leg cramps, or because the baby starts to move and kick. It can be difficult to find a comfortable sleeping position. If possible, try to rest during the day to make up for the loss of sleep.
It is important to find a comfortable sleeping or resting position, but avoid sleeping flat on your back. This can cause your womb to press on the blood vessels in your belly and cause circulation problems. It can also cause problems with digesting food, with back strain, and with breathing.
What to do:
- Drink a little warm milk or hot soup before trying to sleep.
- Sleep sitting up a little, or with something behind you to support your head and shoulders, and put rolled-up cloth or newspaper under your knees.
- Sleep on your side. If possible, lie on your left side as this is the best position for blood circulation. Place something comfortable like rolled-up cloth or newspapers between your knees and ankles.
- Eat nutritious food, making sure to get enough protein, and use only a little salt in your food (but do use a little).
Swollen feet and legs
Many women have problems with swollen feet and legs during pregnancy, especially in the afternoon or in hot weather. Swelling of the feet is usually not dangerous, but severe swelling when you wake up in the morning, or swelling of your hands and face anytime, can be signs of pre-eclampsia (toxemia of pregnancy).
To help with swollen feet and legs, try to lie down on your side for 30 minutes, 2 or 3 times a day. It does not matter which side you lie on. Just sitting with your feet up is not enough. It is best to lie down on your side.
To help prevent pre-eclampsia, eat nutritious food, make sure to get enough protein, drink plenty of water, and use only a little salt in your food (but do use a little).
Movement and balance
During the 9 months of your pregnancy, your body shape will change so much it will probably affect how you move about. This happens to almost all women, whether or not they have a disability. You may find that you start to lose your balance and fall easily. Or that you have problems with bending and picking things up. Because of this, many women with disabilities that affect body movement start to use aids to help with walking and moving about until the baby is born.
If your leg or part of your leg is amputated, and you use an artificial leg, you may find that the prosthesis will not fit properly because your body is heavier and the skin above your amputation has become swollen. If possible, talk with the person who made your artificial leg to see if it can be adjusted. If not, you may need to use crutches, a walker or a wheelchair while you are pregnant.
What to do:
A ‘walker’ can be made from cane, rattan, bamboo or wood. Tie the joints with any strong string, twine or ribbon, or with strips of car tires or bicycle inner tubes.
A walker with 2 front wheels is easier to move than a walker with no wheels, and is more stable than a walker with 4 wheels.
|A cane or walking stick can be made from forest plants.|
Moving during the last weeks of pregnancy
Even women who are not disabled often have difficulties with balance and with moving about during the last weeks of pregnancy. The difficulties are even worse for women with physical disabilities such as paralysis of the lower body, or limited control of muscles. Your large belly will affect daily activities such as washing yourself, dressing, and moving from place to place.
What to do:
Getting up from a lying down position will be easier if you:
A few simple aids can help many women with physical disabilities during the last weeks of pregnancy when movement is the most difficult.
(Velcro), or easy-to-do straps
that fasten in the front
catch urine and stool.
This should be emptied
after each use.
for pulling to sit
the same height
(see page 114)
These are strong, painful contractions of a muscle, usually in the lower leg, especially at night. If you touch the cramped muscle, it may feel like a hard lump. Leg cramps may be caused by not having enough calcium in the diet.
What to do:
- Do not point the toes—even when stretching.
- Do stretching exercises regularly.
- Eat more foods with calcium, such as milk, cheese, yogurt, sesame seeds, and green leafy vegetables. Also, eat bananas.
- Sleep on your side with something soft like rolled-up cloth or newspaper between your knees and with your legs slightly bent.
- Do not lie down or sleep under heavy bed covers, and do not tuck covers tightly around your body.
If your foot or leg cramps:
Soaking your legs in warm water, or putting a cloth soaked in warm water on the cramping area may also help.
These are tightening or pulling of muscles that make it difficult for a person to control her movements. They happen most often to people with cerebral palsy or a spinal cord injury. Women with these injuries can have muscle spasms during labor.
What to do:
- Do not pull or push directly against the tight muscles. This will make them worse.
- Gently hold and support the affected part until the muscle relaxes.
If the back or the whole body is affected by muscle spasms, put something under the head and shoulders to bend them forward a little. This helps to relax stiffness in the whole body.
- Apply warm soaks to the tight muscles or, if possible, sit or lie in warm water. Be careful not to burn the skin or overheat the body, especially if you cannot feel hot or cold things against your skin. Too much heat can cause damage to the unborn baby.
- Gentle stretching exercises done 2 to 3 times each day can help reduce tight muscles.
- Weight-bearing exercise, like standing up, also helps keep muscles strong and reduces muscle tightness.
Most pregnant women, whether or not they have a disability, get back pain, especially in the weeks just before the baby is born when the belly is very big and heavy. Most often this is because the muscles in the belly are stretched and weakened during pregnancy, and the back muscles have to work harder.
Women with some physical disabilities seem to get back pain that is more severe and that happens earlier in the pregnancy. Even women who have no feeling in the lower body often notice back pain while they are pregnant.
What to do:
- Exercise before, during, and after pregnancy to stretch and strengthen the muscles in the lower back and to keep the muscles in the belly strong. Swimming is a good way to reduce back pain and to stay strong.
- Sit in a straight-backed chair.
- Rest, heat, and massage on the painful area can help reduce back pain.
- Wind a piece of clean, thin cotton cloth, about 4 to 5 feet
long (1½ meters) around your belly like this.
- Do not wind it so tight that it is uncomfortable.
- You can keep it in place with a safety pin, or you can tuck in the end of the cloth.
As the baby grows, it pushes against the mother’s lungs and she has less room in her chest to breathe. This is normal in pregnancy. But women with some physical disabilities, such as short stature (dwarfism) or paralysis of the chest muscles, can get short of breath earlier in the pregnancy than other women. The baby gets oxygen from the mother’s lungs, so a pregnant woman must keep her lungs clear and healthy for the developing baby to get all the oxygen it needs.
What to do:
- Sleep sitting up a little. You will be more comfortable if you put something under your knees.
- Drink water often, at least 8 glasses a day. This will help mucus in the lungs stay loose so it is easier to cough up. Mucus in the lungs can cause an infection.
- Get regular exercise.
- If you start coughing up phlegm (mucus with pus), see a health worker. You may need to take medicine, like antibiotics. A health worker can help you decide which antibiotic or other medicine is safe to take while you are pregnant.
Aches and pains in the joints
A pregnant woman’s body gets soft and loose to make room for the baby to grow and to get ready to give birth. Sometimes her joints also get loose and uncomfortable, especially the hips. This usually happens during the last few weeks of the pregnancy. It is not dangerous and will get better after the birth.
What to do:
- Rest the painful joints. Move a little from time to time so that the joints will not get stiff, but your movements should be gentle.
- Applying cold or heat to the painful joint often reduces pain and makes movement easier. Usually cold works best on hot, inflamed joints, and heat on sore, stiff joints. Experiment to see which works best for you. If you cannot feel hot or cold things against your skin, be careful not to burn or freeze yourself.
sore and stiff joints
For cold: Use ice wrapped in a cloth or towel for 10 to 15 minutes.
For heat: Use a thick cloth that has been soaked in clean hot water (squeeze out the extra water) and wrap it around the sore joint. Cover the cloth with a piece of thin plastic, and wrap with a thick dry cloth or towel to hold in the heat. When the wet cloth starts to get cool, put it back in the hot water and repeat.
Or fill a bottle (ceramic, plastic, or glass) with hot water, close it securely, wrap it in a cloth, and hold it against the painful area.
- Take paracetamol (acetaminophen) for pain, 500 mg every 3 to 4 hours. But do not take more than 8 tablets (4000 mg) in 24 hours.
Many women find that as their belly gets bigger, it gets harder to control leaking urine. During pregnancy, women with physical disabilities such as limited muscle control and paralysis or loss of feeling in the lower body often have more problems than other women with leaking urine.
As the baby grows and the mother’s belly gets bigger, the baby may push against the bladder, leaving less room for urine. This can make urine leak out at times, especially when the woman coughs or sneezes. Sometimes the urine comes out so suddenly that it is hard to tell if it is urine or if the ‘bag of waters’ has broken. You may be able to tell by the smell if it urine or not. If this happens, watch for other signs of labor, and ask a health worker or midwife for advice.
If you normally use a catheter each time you want to pass urine, continue to do this if it does not cause you any problems. But if you find it too difficult to put a catheter in more times than usual, try using thick pads of cloth to catch the urine. These pads must be changed, washed and dried often to prevent a rash or an infection on the skin around your genitals. Make sure the pads are clean and dry before using them again.
Some women change to a catheter that is left in all the time (a ‘fixed’ or Foley catheter). But, if possible, try not to do this, because it may be difficult to change back after the baby is born. The muscles that control your bladder will “forget” how to hold the urine inside. Also, having a catheter in all the time can increase the risk of getting a bladder infection.
If you have trouble with leaking urine at night, use pads, or keep a bowl, bucket or something else close by to pass urine into. A convertible wheelchair-toilet may be a good solution.
Difficulty passing stool (constipation)
Many pregnant women have trouble passing hard stools. Pregnancy can make the bowels work more slowly, and this can make the stool more difficult to pass. See information on how to reduce and prevent constipation.
WARNING! Pregnant women should not take medicines called laxatives or purgatives for constipation. These work by making the bowels tighten or contract—and they may cause labor to start too soon. Some can harm the baby.
Also, pregnant women should not wash out the bowels with water (enema). This could also start labor too soon.
Hemorrhoids are swollen veins in and around the anus. They often itch, burn or bleed, and they can be very painful. Hemorrhoids sometimes look like large ‘blood blisters.’ Straining to pass stool when you are constipated makes them worse. Many women, both disabled and non-disabled, get hemorrhoids while they are pregnant. Sitting for a long time seems to make them worse.
What to do:
- Follow the advice for preventing constipation.
- To help shrink the hemorrhoids, soak some clean cloth in a drying (astringent) plant juice, such as witch hazel or cactus, and put it on the painful area.
- Use a cushion when sitting to reduce pressure.
- Try to move at least once every hour.
- If you lie down all the time, try to lie on your side, and have someone help you change position regularly.
- Sit or lean back with your feet and legs up. This will help your blood circulate better and heal the hemorrhoid more quickly.